Provider Demographics
NPI:1528433489
Name:BLANEY, CERISSA (PHD)
Entity type:Individual
Prefix:
First Name:CERISSA
Middle Name:
Last Name:BLANEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MAPLE AVE # 292
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3560
Mailing Address - Country:US
Mailing Address - Phone:401-236-5222
Mailing Address - Fax:
Practice Address - Street 1:18 MAPLE AVE # 292
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3560
Practice Address - Country:US
Practice Address - Phone:401-236-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9421103TC0700X
RIPS01518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical